three joint fusion

The three-joint arthrodesis fusion refers to the fusion surgery of the three joints of the heel, the Achilles, and the boat. The ankle joint remained active after surgery. The purpose of the surgery is to stabilize the joints of the feet, correct the deformities, and restore their function. Since the three articular surfaces are located on two mutually perpendicular planes, different wedge resections can be used to correct the plantar flexion, toe, inversion, eversion, adduction, abduction or high arch deformity; The combined wedge resection allows for three-dimensional correction of the various joint malformations described above. The deformities of the feet vary from one to another, so the degree of osteotomy and fixation methods of the three joints are also different. It should be fully studied before surgery, and different designs should be made for different deformities; during surgery, it should be adjusted at any time according to the findings, in order to receive satisfactory results. Treatment of diseases: high arch Indication 1. Due to joint trauma, inflammation, degeneration, etc., the joint surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, affecting work and life, non-surgical treatment is invalid, and other surgery is not suitable. To maintain joint mobility, joint fusion should be performed. For example, severe arthritis caused by intra-articular fractures of the lower extremities, and there are a large number of scars in the surrounding soft tissue after septic arthritis, and it is not suitable for surgery such as arthroplasty. 2. Adult all-tubular tuberculosis, joint surface destruction, it is estimated that the joint function can not be preserved, joint fusion can be performed at the same time as the lesion is removed; and there are deformities, which can correct the deformity at the same time. 3. Muscle spasm caused by neuropathy or injury, causing severe instability of the joint, affecting the whole limb function, and simple tendon metastasis is not enough to maintain joint stability and restore sufficient effective function. Fixing local joint can improve limb function. Perform joint fusion. For example, after the anterior horn polio of the spinal cord, the upper limbs can not be lifted. If the shoulder joint is fixed in the functional position, the function of the upper limb can be improved by sliding the shoulder between the shoulders. 4. Congenital or acquired spinal deformity (such as hemivertebra, scoliosis, lumbar spondylolisthesis, etc.), in order to prevent the development of deformity, early laminectomy can be performed, or after deformity correction. Contraindications 1. Patients with osteoarthritis adjacent to the joint should not be used for arthrodesis. If the hip joint is fused, its activity can be compensated by the normal lumbar spine and knee joint to meet the needs of work and life activities. If the lower lumbar or knee joint is already stiff, hip fusion will cause great difficulty to the patient. 2. Among the same joints of the limbs, one side has a strong straight, and the contralateral side should not be subjected to arthrodesis. If the hip joints are fused on both sides, it will be very difficult to get up, lie, walk and sit. 3. Children's articular cartilage is rich, joint fusion is not easy to cause bone fusion, but also easy to damage the epiphysis, affecting growth and development; at the same time, children in the limb development stage and muscle sustained action, the fusion joint can be deformed again. Therefore, children under the age of 12 should not undergo arthrodesis. Preoperative preparation 1. The occurrence and development of foot deformity is closely related to muscle spasm, muscle imbalance, soft tissue contracture, and bone deformity. Relieving soft tissue contracture can reduce bone resection, which is conducive to the correction and consolidation of deformity. Therefore, soft tissue contracture deformity (such as achilles tendon, tendon fascia, joint capsule, etc.) should be loosened before surgery, or at the same time during surgery. Carry out (with the contracture surgery should not be carried out at the same time). For those with muscle imbalance, if they are left without correction, although the three joints are merged, the deformity can still be recurred (such as the anterior tendon tendon, and the plantar flexion, valgus, and abduction deformity can still be reappeared after the operation. ), assisted tendon transfer surgery should also be performed at the same time or after surgery. Therefore, before the operation, not only the bone deformity, but also the muscle strength, local soft tissue, gait and adjacent joint function and other conditions should be examined and studied in detail, and then a complete surgical plan can be set. 2. Long-term foot deformity can cause secondary deformities of adjacent bones and joints (such as knee inversion, valgus, and tibial rotational deformity). These deformities are best corrected before surgery to correct the deformity of the foot; if it can not be corrected before surgery, it should be arranged in the short term after surgery, otherwise it will affect the effect of the three joint fusion. 3. When the ankle joint is unstable, it is not suitable for simple three-joint fusion. It is necessary to add ankle joint fusion, otherwise it will be deformed again after operation. 4. Preoperative preoperative and lateral X-ray films of the foot, depicting the drawings, and cutting according to the requirements of the functional position, can test the surgical design, and also facilitate the correct design of the bone resection range, the angle of the resection and the wedge-shaped bone, and Choose the method of surgery. 5. Use warm water for 3 days before surgery to clean the skin and soften the skin for surgery. Surgical procedure 1. Position: The lateral position, the healthy limb is flexed in the lower part, the diseased limb is straight, and the foot is padded with sandbags. 2. Incision, exposure: All operations were performed under the tourniquet. With a curved incision of the external malleolus, the front end starts from the front of the scaphoid and the rear end bypasses the trailing edge of the outer iliac crest (see the lateral approach of the lower joint). In the exposure, attention should be paid to the subcutaneous separation. The whole layer should be separated after the separation of the deep tissue to ensure the blood supply. When the subperiosteal peeling adheres to the short toe muscles on the lateral side of the talus, care should be taken to maintain the integrity of the muscles. Do not damage the nerve and blood vessel supply from the medial side to cover the bone surface and fill the dead space. Turn the muscles distally to reveal the three joints. 3. Resection of the articular surface: If the diseased foot is not deformed, just use the osteotome to remove the cartilage surface of the three joints so that they can be closely aligned. Generally, the articular surface of the heel is removed first, and the posterior part is more difficult to expose. It is easy to have a defect in the cartilage surface and affect healing. In order to prevent omission, the talus to the calcaneus should be cut first, then the protruding part of the talus of the posterior joint of the posterior joint should be removed, and then the calcaneus should be inverted to fully reveal the posterior joint. The cartilage surface of the articular cartilage was removed under direct vision. When removing the inside of the joint, care should be taken to prevent the scalpel from damaging the posterior vascular bundle, the long toe, or even the skin. Followed by the resection of the ankle joint surface and the joint surface of the boat. The surface of the joint of the boat is squat-shaped, and its inner side is curved to the rear, which is difficult to reveal; the forefoot should be adducted as much as possible, and the curved joint should be used to remove the articular surface. The extensor tendon and the blood vessels and nerves in the front of the joint should be gently opened and properly protected. 4. Wedge-shaped osteotomy, correction of deformity: If the diseased foot has bone deformity, it should be designed as a wedge-shaped osteotomy according to the preoperative design. The surrounding soft tissue is first protected separately and then removed with a flat wide bone knife commensurate with the width of the bone. The degree of bone removal should be different according to the characteristics of the deformity. The principle is that the deformed protrusion surface is cut more, and the apex angle of the wedge should be directed to the concave surface so as to correct the deformity. The bones that have been cut should be kept for bone grafting. The principle of osteotomy for various foot deformities is now described as follows: Intra-foot and valgus deformity: The lateral wedge-shaped osteotomy of the heel joint is used to correct the deformity. The base of the varus wedge-shaped osteotomy is to the outside, and the valgus is to the medial side. Forefoot adduction, abduction deformity: mainly to correct the deformity of the lateral wedge-shaped bone from the boat and the Achilles tendon. The abduction deformity has a base of the wedge-shaped osteotomy to the medial side, and an adductor to the lateral side. Deformation of the plantar flexion and the high toe of the toe: The wedge is used to cut the bone from the dorsal and posterior aspect of the ankle joint, and the anterior and posterior wedge-shaped osteotomy of the heel joint is used to correct the deformity. Lambrinudi surgery should be used for severe ankle flexion and spastic deformity. It is also the principle of applying the above scheme. That is, most of the talus-based three-joint fusion is removed under the extreme flexion of the iliac crest, and the anterior portion of the talus is inserted into the trough of the lower part of the scaphoid, so that the foot has no flexion, but it still has a small amount of dorsiflexion. 5. Tendon metastasis and bone grafting: If there is muscle imbalance, muscle tendon transfer should be performed at the same time. The tendon to be transferred is completely prepared before the bone is cut, and is transferred to the bone of the predetermined bone after the correction of the deformity of the osteotomy (see the tendon surgery). 6. Stitching: After the deformity is corrected, the person is kept at the functional position, and the bone cut surface is checked for good fit, and there is no soft tissue sandwiched between the bones. If there is a gap between the bone and the joint surface, the excised pine bone should be used for filling. The mating surface can be fixed by the staple nail, and the memory alloy nail has a certain pressing effect. Finally, the short toe and soft tissue of the toe is filled into the sinus sinus to eliminate the dead space, and the layer can be sutured layer by layer. 7. External fixation: post-fixed with long-legged plaster boots, it should be well shaped to maintain the corrected position until the plaster is dry and then cut on the back or sides. If edema affects blood supply after surgery, it can be released in time to improve blood supply.

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